Friday, 30 January 2015

The Nazi holocaust – let’s not forget the lessons of history and the leading role doctors played

This week has seen two significant anniversaries that have
revived memories of the Second World War, and in particular what Britain was
spared from.

First was the 50th anniversary of the death of
the great wartime British Prime Minister Winston Churchill on 24 January 1965.

Second was the 70th anniversary of the liberation
of prisoners from the Auschwitz-Birkenau concentration camp – Holocaust
Memorial day. More than one million people, mostly Jews, died at the Nazi camp
(pictured) before it was liberated by allied troops on 27th January
1945.

Earlier this week a Jewish figurehead sparked
controversy by suggesting that new draft legislation seeking to
decriminalize assisted suicide in Scotland is based on similar principles to
racist Nazi laws that paved the way for the Holocaust.

Ephraim Borowski,
director of the Scottish Council of Jewish Communities, spoke out against Patrick
Harvie’s Assisted Suicide Bill which is currently making its way through
Holyrood in an evidence session with MSPs.

He referred to Holocaust
Memorial Day to make ‘a point about practicalities rather than principles’ and
added: ‘It's now a well-known cliche that the Holocaust didn't begin in
Auschwitz, it ended in Auschwitz. In terms of principle, it began with the
belief that some lives are not worth as much as others, and that is precisely
what we are faced with here.’

Understandably his claims have elicited appeals to ‘Godwin’s law’ - an adage asserting that ‘As an online
discussion grows longer, the probability of a comparison involving Nazis or
Hitler approaches 1’.

But rather than dismissing Borowski’s comparison out of hand critics should
spend some time examining the historical evidence-base behind it because it is
considerable.

The horrific genocide of six million Jews was in fact only
the final chapter in the Nazi holocaust story.

The detail of how it happened, and particularly the role
of doctors in the process, is not at all well known.

What ended in the 1940s in the gas chambers of Auschwitz,
Dachau and Treblinka had much more humble beginnings in the 1930s in nursing
homes, geriatric hospitals and psychiatric institutions all over Germany.

When the Nazis arrived, the medical profession was ready and waiting.

Twenty three physicians (see below) were tried at the so-called Nuremberg
Doctors' Trial in 1946, which gave birth to the Nuremberg Code of ethics
regarding medical experiments.

Many others including some of the very worst offenders never
came to trial (see list of main perpetrators here and
full list here)

How did it actually happen?

Our story begins with Germany emerging from the First World War defeated,
impoverished and demoralised.

Into this vacuum in 1920 Karl Binding, a distinguished lawyer, and Alfred
Hoche, a psychiatrist, published a book titled ‘The granting of permission for
the destruction of worthless life. Its extent and form'.

In it they coined the term ‘life unworthy of life’ and argued that in certain
cases it was legally justified to kill those suffering from incurable and
severely crippling handicaps and injuries. Hoche used the term
ballastexistenzen (‘human ballast’) to describe people suffering from various
forms of psychiatric disturbance, brain damage and retardation.

By the early 1930s a propaganda barrage had been launched against traditional
compassionate 19th century attitudes to the terminally ill and when the Nazi
Party came to power in 1933, 6% of doctors were already members of the Nazi
Physicians League.

In June of that year Deutsches Arzteblatt, today still the most respected and
widely read platform for medical education and professional politics in
Germany, declared on its title page that the medical profession had
‘unselfishly devoted its services and resources to the goal of protecting the
German nation from biogenetic degeneration’.

From this eugenic platform, Professor Dr Ernst Rudin, Director of the Kaiser
Wilhelm Institute of Psychiatry of Munich, became the principle architect of
enforced sterilisation. The profession embarked on the campaign with such
enthusiasm, that within four years almost 300,000 patients had been sterilised,
at least 50% for failing scientifically designed ‘intelligence tests’.

By 1939 (the year the war started), the sterilisation programme was halted and
the killing of adult and paediatric patients began. The Nazi regime had
received requests for ‘mercy killing’ from the relatives of severely
handicapped children, and in that year an infant with limb abnormalities and
congenital blindness (named Knauer) became the first to be put to death, with
Hitler’s personal authorisation and parental consent.

This ‘test-case’ paved the way for the registration of all children under three
years of age with ‘serious hereditary diseases’. This information was then used
by a panel of ‘experts’, including three medical professors (who never saw the
patients), to authorise death by injection or starvation of some 6,000 children
by the end of the war.

Adult euthanasia began in September 1939 when an
organisation headed by Dr Karl Brandt and Philip Bouhler was set up at
Tiergartenstrasse 4 (T4) (pictured left The aim was to create 70,000 beds for
war casualties and ethnic German repatriates by mid-1941.

All state institutions were required to report on patients who had been ill for
five years or more and were unable to work, by filling out questionnaires and
chosen patients were gassed and incinerated at one of six institutions (Hadamar
being the most famous).

False death certificates were issued with diagnoses appropriate for age and
previous symptoms, and payment for ‘treatment and burial’ was collected from
surviving relatives.

The programme was stopped in 1941 when the necessary number of beds had been
created. By this time the covert operation had become public knowledge.

The staff from T4 and the six killing centres was then redeployed for the
killing of Jews, Gypsies, Poles, Russians and disloyal Germans. By 1943 there
were 24 main death camps (and 350 smaller ones) in operation.

Throughout this process doctors were involved from the earliest stage in
reporting, selection, authorisation, execution, certification and research.
They were not ordered, but rather empowered to participate.

Leo Alexander (right), a psychiatrist with the Office of the Chief of Counsel
for War Crimes at Nuremberg, described the process in his classic article 'Medical Science
under Dictatorship' which was published in the New England Medical
Journal in July 1949.

‘The beginnings at first were merely a subtle shift in emphasis in the basic
attitude of the physicians. It started with the attitude, basic in the
euthanasia movement that there is such a thing as a life not worthy to be
lived. This attitude in its early stages concerned itself merely with the
severely and chronically sick. Gradually the sphere of those to be included in
this category was enlarged to encompass the socially unproductive, the
ideologically unwanted, the racially unwanted and finally all
non-Germans.’

The War Crimes Tribunal reported that ‘part of the medical profession
co-operated consciously and even willingly’ with the ‘mass killing of sick
Germans’.

Among their numbers were some of the leading academics and scientists of the
day; including professors of the stature of Hallervorden (neuropathology),
Pernkopf (anatomy), Rudin (psychiatry/genetics), Schneider (psychiatry), von
Verschuer (genetics) and Voss (anatomy). None of these men were ever prosecuted
while of the 23 defendants at Nuremberg, only two were internationally
recognised academics.

It is easy to distance ourselves from the holocaust and those doctors who were
involved. However, images of SS butchers engaged in lethal experiments in
prison camps don’t fit the historical facts; the whole process was orchestrated
through the collaboration of internationally respected doctors and the State.

With the advantage of hindsight we are understandably amazed that the German
people and especially the German medical profession were fooled into accepting
it. The judgement of the War Crimes Tribunal in 1949 as to how they were fooled
was as follows.

'Had the profession taken a strong stand against the mass
killing of sick Germans before the war, it is conceivable that the entire idea
and technique of death factories for genocide would not have materialized...but
far from opposing the Nazi state militantly, part of the medical profession
co-operated consciously and even willingly, while the remainder acquiesced in
silence. Therefore our regretful but inevitable judgement must be that the
responsibility for the inhumane perpetrations of Dr Brandt (pictured
left)...and others, rests in large measure upon the bulk of the medical profession;
because the profession without vigorous protest, permitted itself to be ruled
by such men.' (War Crimes Tribunal. 'Doctors of Infamy'. 1948)

The British Medical profession and the Holyrood parliament need to take note.

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Kiwi, Christian and Medical

This blog deals mainly with matters at the interface of Christianity and Medicine. But I do also diverge into other subjects - especially New Zealand, rugby, economics, developing world, politics and topics of general Christian and/or medical interest. The opinions expressed here are mine and may not necessarily reflect the views of my employer or anyone else associated with me.

About Me

I am CEO of Christian Medical Fellowship, a UK-based organisation with 4,500 UK doctors and 1,000 medical students as members. The opinions expressed here however are mine, and may not necessarily reflect the views of CMF or anyone else associated with me.